(NEW 03/01/2024 ML# 3846)
Purpose
The purpose of Provider Enrollment is to ensure that Qualified Service Providers (QSPs) meet the standards and qualifications set by the Department of Health and Human Services (HHS) and Federal Regulations for providing services to eligible Home and Community Based Service recipients.
Legal Authority
Code of Federal Regulations (CFR) Title 42, Chapter IV, Subchapter C, Part 455, Subpart E
Century Code 50-11-02.4
Century Code 50-11-06.8
Century Code 50-11-06.9
N.D. Admin. Code 75-03-23-07
N.D. Admin. Code 75-03-23-08
N.D. Admin. Code 75-03-23-10
N.D. Admin. Code 75-03-21-08
Standards for Qualified Service Providers
Must be 18 years of age.
Must meet the standards of CFR Part 455-Program Integrity Medicaid.
Must meet the provider standards and agreements according to the N.D. Admin. Code and CFR.
Per ND Admin. Code 75-03-23-08(1)(n)(2)(o)(p), QSPs must have been actively billing in the past 12 months or have valid reason for inactivity to revalidate or they may be closed for inactivity.
No outstanding debts can be owed to the Department.
If an outstanding debt is owed to the Department, payment arrangements may be considered as an allowance and condition of enrollment approval.
Documentation of Competency, registered nurse licensure, licensed practical nurse, certified nurse assistant certification, physician, physician assistant, nurse practitioner, physical therapist license, or occupational therapist must be current and up to date. (FHC does not require a documentation of competency)
Family home care and family personal care providers must have an eligible individual identified by the HCBS Case Manager before enrollment will be completed.
Bureau of Criminal Investigation background checks and fingerprint screening must be done for Adult Foster Care (AFC) and Respite providers in an AFC home per Admin. Code 75-03-21-08(1)(h) and Century Code 50-11-02.4, 50-11-06.8, and 50-11-06.9.
QSPs must have an email account to create an account in the QSP Portal and receive correspondence from the Department.
Paperless communication is the preferred method of communication. However, individuals who need accommodation can request information to be sent in a different format. Contact the QSP Hub to request accommodation.
For additional information about provider standards refer to the current QUALIFIED SERVICE PROVIDER (QSP) HANDBOOKS, available on the QSP website: https://www.hhs.nd.gov/human-services/providers/adults-and-aging/qualified-service.
Standards for Qualified Service Providers (QSP) for Environmental Modification
Environmental Modification Service may only be provided by a contractor approved by the Department of Health and Human Services as a QSP. Standards for QSPs of Environmental Modification Service are as follows:
Building contractors must have a current North Dakota Contractor's license, carry liability insurance, be bonded, and maintain good standing with Workforce Safety Insurance. Show verification of an appropriate building permit.
Electricians must be licensed by the North Dakota State Electrical Board, carry liability insurance, be bonded, and maintain good standing with Workforce Safety Insurance.
Plumbers must be licensed by the North Dakota State Plumbing Board, carry liability insurance, be bonded, and maintain good standing with Workforce Safety Insurance.
All licensed and unlicensed contractors must provide a copy of their registration with the Secretary of State; provide a copy of their license, proof of liability insurance/bonding, and proof of enrollment and good standing with Workforce Safety and Insurance. These documents must be submitted with the request to be a Qualified Service Provider (QSP).
The North Dakota Century Code (NDCC 43-07-02) allows for a handyman to complete jobs not exceeding $4000 without a contractor’s license. If the handyman does not have a contractor’s license they must provide a letter of reference showing they meet the qualifications to do minor installs and modifications to the home. The handyman would be allowed to provide installs and modifications to the home not exceeding $4000 in time and materials. A licensed contractor would qualify as a QSP with their contractor’s license and is not limited to the $4000 threshold.
An unlicensed handyman/contractor/tradesman may meet the QSP criteria for Environmental Modification with the following requirements:
Verification of good standing with Workforce Safety and Insurance.
Standards for Home Delivered Meal Providers:
Enrolled as an individual or agency Qualified Service Provider;
Licensed as a food establishment pursuant to NDCC 23-09, Hospital, nursing facility, basic care facility; or contracted with Aging Services Division as an OAA Nutrition Provider;
Meet all applicable federal, state, and local laws and regulations regarding the safe and sanitary handling of food, equipment, supplies and materials used in storage, preparation, and delivery of meals to eligible recipients pursuant to the ND Requirements for Food and Beverage Establishments (NDAC 33-33-04).
Providers licensed as a Hospital must also meet standards pursuant to NDCC 23-16, NDAC 33-07-01.1, & NDAC 33-07-02.1
Providers licensed as a nursing facility must also meet standards pursuant to NDCC 23-16 & NDAC 33-07-03.2 & NDAC 33-07-04.2
Providers licensed as basic care must also meet standards pursuant to NDCC 23-09.3 & NDAC 33-03-24.1
Providers licensed as basic care must also meet standards pursuant to NDCC 23-09.3 & NDAC 33-03-24.1
Provider Enrollment Limitations
All verification screenings required by the federal and state laws, rules, or regulations must be complete before enrollment can be finalized.
The QSP enrollment effective date cannot be prior to the provider NPI enumeration date, if applicable.
The effective date for QSP enrollment for services of Family Home Care (FHC) or Family Personal Care (FPC) may not be prior to individual/member’s signature on care plan.
Provider Reimbursement Limitations
QSP’s will not be paid with public funds until the enrollment requirements are fulfilled and a current authorization is received from the Case Manager.
QSP’s will not be eligible for payment during the period when their QSP enrollment status lapsed.
QSP’s are not eligible for payment earlier than the effective date on the authorization to provide services issued by the case manager, therefore the enrollment date may not be the date a provider can start billing.
QSPs are required to provide a direct deposit account upon initial enrollment and maintain a current checking or savings account for direct deposit at all times. If the QSP does not maintain a current account or update HHS when updated information is requested, the QSPs enrollment status will be closed.
Enrollment Process for New Applicants
A complete and accurate application including all forms and required verification checks by QSP Enrollment must be complete before an enrollment approval will be given (enrollment dates cannot be retroactive).
The following provider verifications must be completed by QSP Enrollment according to the CFR and state regulations:
Verification of current competency, certification, or licensure and good standing in state
List of Excluded Individuals and Entities (LEIE)(OIG)
Excluded Parties List System (SAMS)
National Sex Offender Site
ND Sex Offender Site
Check Termination and Denial list
Check Certified Nurse Assistance Abuse list
Health Market Science (HMS) or equivalent screening check which includes the following:
OIG (Office of Inspector General)
State Medicaid Exclusion
Social Security Administration Death Master File
National Plana and Provider Enumeration System (NPPES) or NPI (National Provider Identifier) Registry
DEA (Drug Enforcement Administration)
Addresses
A QSP will be issued an “enrollment expiration date” no longer than 60 months from the date of enrollment approval.
Enrollment Process for Family Home Care (FHC) and Family Personal Care (FPC)
The case manager must initiate the application for the FHC or FPC provider in the QSP Enrollment portal.
The QSP applicant submits a complete and accurate application, including uploading the required documentation in the QSP enrollment portal.
QSP Enrollment must complete required screening and verification checks according to the CFR and state regulations:
Verification of current competency, certification, or licensure and good standing in state
List of Excluded Individuals and Entities (LEIE)(OIG)
Excluded Parties List System (SAMS)
National Sex Offender Site
ND Sex Offender Site
Check Termination and Denial list
Check Certified Nurse Assistance Abuse list
Health Market Science (HMS) or Accurint check which includes the following:
OIG (Office of Inspector General)
State Medicaid Exclusion
Social Security Administration Death Master File
National Plana and Provider Enumeration System (NPPES) or NPI (National Provider Identifier) Registry
DEA (Drug Enforcement Administration)
Addresses
Family Home Care does not require an SFN 750- Documentation of Competency.
Family Personal Care requires a valid proof of competency with the application.
Valid proof of competency includes a SFN 750 or current CNA, RN or LPN verification.
The effective enrollment date for the services of Family Home Care or Family Personal Care may not be prior to the date of the individual/member’s signature on the care plan.
The HCBS case manager verifies the QSP applicant will be providing FHC or FPC with QSP Enrollment before final approval will be granted.
A start date will be determined by reviewing:
The completed application;
Provider screening verification date;
Individual approval date for service;
The QSP will be issued an “enrollment expiration date” no longer than 60 months from enrollment approval date.
Revalidation of QSP enrollment is required every sixty months for an individual enrolled as a FHC or FPC QSP.
Revalidation of QSP enrollment is required every sixty months for an individual enrolled as a FHC or FPC QSP.
HCBS Case Management Guidance for Family Home Care and Family Personal Care QSP Application
Step 1: Ask the potential QSP what email they want to use to set up their ND Portal account.
If they don’t have an email, they should use one of the free email sites (yahoo, google etc.) to set one up. They need to keep track of the email and check it frequently. If they want to use someone else’s email for this, they must have written permission from the eligible individual.
If they don’t know how to set up an email, they can contact the QSP Hub for assistance. (Please note that they will likely need to schedule a time and help may not be available on demand due to the volume of TA being requested.)
Step 2: The potential QSP should follow the attached user guide for family home care or family personal care and log into their current ND portal or set up a new account in the ND portal. If they need help with this step, they can call the QSP Hub and set up a time.
Step 3: The potential QSP should let you know when they have logged into their ND portal account.
Step 4: The HCBS Case Manager should follow the attached user guide and log into the QSP portal and initiate a FHC or FPC application.
Step 5: The HCBS Case Manager should let the potential QSP know they can log into the QSP portal (using the correct email) and fill out the FHC or FPC application. They will be notified via email when the application is approved. You will be able to see the application and each stage of the process for each application you initiate.
Enrollment Revalidation
A notice will be sent through the QSP Enrollment Portal when QSP revalidation is due.
Note: Paperless communication is the preferred method of communication. However, individuals who need accommodation can request information to be sent in a different format. Contact the QSP Hub to request accommodation.
A complete and accurate application including all forms and required verification checks by QSP Enrollment must be complete before revalidation of QSP status can be approved.
The following provider verifications must be completed by QSP Enrollment according to the CFR and state regulations:
Verification of current competency, certification, or licensure and good standing in state
Evidence of competency is required at least every sixty (60) months for an agency enrolled as a qualified service provider or at least thirty (30) months for an individual enrolled as a qualified service provider.
List of Excluded Individuals and Entities (LEIE)(OIG)
Excluded Parties List System (SAMS)
National Sex Offender Site
ND Sex Offender Site
Check Termination and Denial list
Check Certified Nurse Assistance Abuse list
Health Market Science (HMS) or Accurint check which includes the following:
OIG (Office of Inspector General)
State Medicaid Exclusion
Social Security Administration Death Master File
National Plana and Provider Enumeration System (NPPES) or NPI (National Provider Identifier) Registry
DEA (Drug Enforcement Administration)
Addresses
QSP is given an “enrollment expiration date” no longer than 60 months from enrollment approval date.
Individual QSPs will be given a 30-day notice in the Enrollment Portal to revalidate their enrollment.
Agency QSPs will be given a 90-day notice in the Enrollment Portal to revalidate their enrollment.
If revalidation is not completed by the expiration date, the QSP is given a stop date and sent written notification of 30 extra days to revalidate. A new start date will be given if/when a complete application is received and approved.
HCBS Case Manager and/or the DD Program Manager will be sent a written notification of a 30 day stop notice period, allowing the provider 30 extra days to revalidate. If revalidation is not received and processed during the 30 day stop notice period, the QSP must be taken off the care plan.
QSP wishing to continue to provide care must have a complete application submitted and approved before the final stop date issued in the 30-day notice. (There will be no retroactive dates after the 30-day notice).
Exceptions
Requests for exceptions will be reviewed and considered but will not be granted unless the provider meets all the competency requirements and all required screenings and verifications have been completed.
Prior approval is required by the QSP or HCBS Program Administrator.
Competency Revalidations
Individual QSP competency is valid for the length of their license if verified by a CNA, LPN or RN or 30 months if verified by an SFN 750, Documentation of Competency. The Individual QSP is required to revalidate their competency by re-establishing proof of competency at least every 30 months or at the expiration of their certificate or licensure.
Agency QSP employee competency is valid for the length of their license if verified by CNA, LPN or RN or 60 months if verified by an SFN 749 –Documentation of Competency – Agency QSP Employee. The Agency employee is required to revalidate their competency by re-establishing proof of competency at least every 60 months or at the expiration of their certificate or licensure.
QSPs enrolled for a service that is dependent upon a license must submit proof of license renewal to maintain enrollment for the specific service.
A notice will be sent through the QSP Enrollment Portal when an updated competency or license renewal/revalidation is due. The QSP must provide updated information as requested or enrollment will be closed.
Provider Addresses
QSP mail returned twice, with no forwarding address, will result in a closure of QSP status. The HCBS Case Manager or DD Program Manager will be notified of closure date.
If the QSP provides a valid address and meets all provider enrollment requirements, the QSP status will be opened; however, there may be a gap in enrollment approval dates.
If the QSP mail is returned notifying the department that the QSP has moved to a state that does not border North Dakota, the QSP will be closed and given a stop notice.
Closure for Inactivity
QSPs with no billing activity within the last 12-15 months will receive a non-billing notice. The notice will allow the QSP time to provide the Department of the reason for inactivity.
If a valid reason for inactivity is not received within 30 days, the QSP status will be stopped.
15 minute unit rates
Providers must deliver at least 8 minutes of service before they can bill for the first 15 minute unit. Providers should not bill for services performed for less than 8 minutes. This applies to all procedure codes billed using a 15 minute unit rate.
The amount of time required to bill for a larger number of units is as follows:
2 units: at least 23 minutes 6 units: at least 83 minutes
3 units: at least 38 minutes 7 units: at least 98 minutes
4 units: at least 53 minutes 8 units: at least 113 minutes
5 units: at least 68 minutes
The pattern remains the same for allowable tasks performed in excess of 8 units (2 hours).
Daily Rate Service Rates
Add Providers must provide one hour of service to bill for daily rate services.
Electronic Visit Verification Requirements
Electronic Visit Verification (EVV) uses a mobile device application on a phone, tablet, or laptop that records the beginning and ending time of services provided to individuals by providers. Data may also be captured using a fixed object device (FOD) issued to the provider by HHS. This electronically verifies the service was provided at a particular location where the service is authorized, as required by the law. EVV is a federal requirement from the 21st Century Cures Act and became effective January 1, 2021, it is used for billing and payment of services you provide as a QSP.
All QSPs are required to participate in an EVV system if they enroll in at least one of the services subject to EVV. QSPs must have access to a FOB, phone, tablet, or laptop to utilize this system. This is necessary to check in and out when providing services, receiving service authorizations, and submitting claims electronically. Not all services require EVV to bill for services provided.
EVV programming under Therap includes the option to enter and store the documentation that is required for QSP services. This programming is called ISP Data and meets the standard for QSP documentation. ISP Data is only available to QSPs using Therap for EVV.